CRA 16 AC 4412(3)CRAY Ford LIBRARY Urban District of Crayford Annual Report OF THE Medical Officer of Health For the Year 1951 BY JOHN LANDON M.R.C.S., L.R.C.P., D.P.H. Urban District of Crayford Anuual Report OF THE Medical Officer of Health For the Year 1951 BY JOHN LANDON M.R.C.S., L.R.C.P., D.P.H. The Sparta Press, Crayford MEMBERS OF THE HEALTH COMMITTEE. Chairman: Councillor: C. Hetherington. Members: Councillors: H. E. Clark F. A. Gerrard J. W. Howell Councillors: J.Kerr N.E.Killick, J.P. J.W. Taylor (Mrs.) M. M. Hetherington (Mrs.) E. Saxby Mrs. E. J. Borrie, Mrs. M. Jones, Mrs. L. Woolley Medical Officer of Health: John Landon, M.R.C.S., L.R.C.P., D.P.H. Sanitary Inspectors: R. Milligan, Cert. R. San.I., M.S.I.A. A. W. Kent, M.R.S.I., M.S.I.A. Chief Clerk: Mrs. G. Mitchell. Clerks: E. T. Shutte Miss M. H. Millington Rodent Operator: W. McCulla Co-opted Members: Public Health Staff. 2 Crayford Urban District Council To the Chairman and Members of the Urban District Council. Mr. Chairman, Ladies and Gentlemen, I have the honour to present my Annual Report for the year 1951. The vital statistics of the Urban District are, broadly, satisfactory and present a number of interesting feaures. The birth rate during 1951 was 13.9 per thousand of the home population compared with 15.6 per thousand in 1950, 17.9 in 1949, 18.4 in 1948, 22.0 in 1947, 22.0 in 1946, 18.8 in 1945 and 23.1 in 1944. It will be seen that the increase in the birth rate towards the end of the war has not been maintained and the birth rate in fact shows a continued rate of decline which, in general, follows the trend in the birth rate for the country as a whole, although the birth rate for Crayford is appreciably lower than the national rate (15.5). There is a number of posible explanations. Firstly, the housing position is a major deterrent to young married people to start a family. Added to this is the high cost of living, including the high cost of setting up a home. The birth rate for the District corrected by the use of the Registrar General's comparability factor (0.93) was 12.9. Bearing in mind the low death rate which we enjoy nowadays and the fact that the level of the population is being maintained only by the fertility of the past, two things are obvious; firstly that the number of old people must increase and secondly, (seeing that we are all mortal) the death rate must be expected to rise and the population stabilised at a lower level based on present day fertility factors. The death rate for the District during 1951, was 9.56 compared with 7.89 for 1950, or, after correction by means of the comparability factors for deaths (1.21) 11.6 compared with an uncorrected death rate for the country as a whole of 12.5. The infant mortality rate for 1951, at 20.7 per thousand live births, was considerably lower than the rate for 1950, 3 namely, 27.6. The number of babies who died in the first year of life per thousand live births during 1951 was 8 compared with 12 in 1950. The rate for 1951 compares favourably with a rate of 29.6 for the country as a whole. It is necessary to point out that the trend of infant mortality in a district such as this, based as it is on relatively small number of deaths, must not be judged by small annual fluctuations which may be you to fortuitous circumstances, but over a period of years and by this criterion our figures are very satisfactory. There were no maternal deaths during the year, which reflects credit on the local midwifery services, bearing in mind the fact that there were 387 live births during the year, in addition to 9 still births. The incident of infectious disease within the District continued to be very low. No case of diphtheria was notified during the year under review, and in fact only 2 cases of this disease have occurred in the District since 1942. Although this is eminently satisfactory, there is an implied denger in the freedom from this disease in that the young mothers of to-day have never seen a child with diphtheria or heard of a child recently dying from this cause. There is a noticeable tendency for diphtheria immunisation to be neglected in many cases. It cannot be too strongly stressed, however, that our present freedom from this disease is dependent on a continued high level of immunisation of young children as a group and parents should realise that they have both a public and a private duty to perform in this matter. Although there were 682 cases of measles there was only one death from this cause. 134 cases of whooping cough were notified without a single death. These two diseases, with the exception of tuberculosis, are the two most important infectious diseases experienced at the present time, leaving out for the moment the unpredictable incidence of poliomyelitis. Constant vigilance has to be exercised in regard to the prevention of smallpox. As a result of the Brighton epidemic in 1950/51, 22 contacts were traced to this area and vaccination was carried out by the Health Department in most cases and intensive supervision exercised during the danger period On two other occasions ships arrived in nearby ports carrying a case of smallpox and contacts were traced to this area. Vac 4 cination was carried out wherever necessary and the appropriate surveillance exercised. During 1951, 37 cases of paratyphoid fever occurred in an area covering adjacent London boroughs and districts in Kent and Sussex. The cause of the outbreak was judged to be synthetic cream supplied from a food establishment in a neighbouring district. Some of the cases occurred in the Urban District, an extensive investigation developed and it is likely that the control measures which were instituted prevented a more widespread epidemic. Generally speaking the infectious diseases which took such a heavy toll of life and health in the past have diminished in importance but continued vigilance is needed as some change in the natural history of the organisms or some lowering of individual resistance in peace or in war may precipitate a return to former conditions. Tuberculosis remains the most important of the infectious diseases which are encountered. It is a tragedy tha this disease which is preventable is not being prevented. It resents a medico-social problem of great complexity, a description of which is outside the scope of this foreward. I would d emphasise one aspect, however, which demands immedlate attention, namely, the discharge from sanatorium to their own homes of open, i.e. infectious, cases when their continued stay in hospital can no longer be of benefit to them. These, freuently, chronic cases are responsible for a good deal of mishief and our powers under the Public Health Act, 1936. to ontrol this source of infection are inadequate in that such patients may only be compulsorily removed to hospital provided suitable accommodation is available for them. In my view an anomalous position has arisen in regard to he domiciliary tuberculous patient. The presence of a tuberculous person in a household is, often, regarded by the Housing Committee, and rightly so, as grounds for the rehousing of the patient or of a second family, especially if it includes young children, who are occupying the same premises. It would, perhaps, be more efficacious and less costly to remove the source of infection to suitable hospital or other accommodation. 5 During the year a Tuberculosis Care Committee for Crayford was brought into being for the purpose of assisting patients and their dependents. Previously Crayford had been served by the Erith and Dartford Committees. In view of the continued growth of the District it was felt that a Committee to deal with Crayford patients was needed. The scheme which has been well supported, has made good progress. The care of old people living alone is becoming more and more a responsibility of the Health Department. Under Section 47 of the National Assistance Act, 1948, as amended by the National Assistance (Admendment) Act, 1951, it is the responsibility of the local authority to take appropriate action in the cases of persons "who are suffering from grave chronic disease or being aged and infirm or physically handicapped are living in insanitary conditions and are unable to devote to themselves, and are not receiving from other persons, proper care and attention." The effects of the ageing of the population are now being felt in the increase of such cases. Old people are often discovered to be living in conditions grotesque from the point of loneliness and the absence of even the lowest standards of comfort, care and cleanliness. These old people are nearly always infirm to a greater or lesser extent and I would like to express my appreciation of the help which is so readily forthcoming from the Officers of the Woolwich Group Hospital Management Committee who do their best under difficult circumstances to find accommodation for these urgent cases. The affiliation of the local Good Neighbours Association to the North West Kent Old People's Welfare Committee, operating under the North West Kent Council of Social Service, has now taken place and the experiment is being tried of appointing district liaison officers somewhat on the lines of the Tuberculosis After-Care Committee. The work of the new committee will be, firstly, to ascertain on a Ward basis the old people needing additional care, to Co-ordinate the work of all agencies providing for the care of old people and to afford to the latter a wide range of good neighbourly services. One of the added functions will be the raising ot funds from various charitable sources and the assistance of old people, in suitable cases, by small monetary grants or their equivalent in food and other requirements needed for their comfort. Although the State is now responsible tor a 6 wide range of statutory services for old people, it is considered essential that each local community should interest itself in the deprived old people who are living in their midst. The joint Clean Food Campaign with Erith and Bexley goes forward slowly but steadily and good progress has been made in what is essentially a long term health education project. In April, 1951, a clean food exhibition was held and was reasonably well supported by the general public. Organised parties of school children from the three areas visited the exhibition and lectures and film shows were given. Codes of Practice have now been formulated for all the main food trades and applications for membership have now been received from 98 food traders, of which 19 have been approved to date. There is still a great deal of work to be done in this sphere during the next few years to bring into membership the majority of the food traders in the area. An attractive plaque has now been prepared which, we hope, will become more and more familiar to the public as they appear in increasing numbers in the windows and on the premises of the food establishments in the Urban District. The prevention of accidents in the home is being recognised more and more as coming within the realm of preventive medicine and therefore a legitimate field of endeavour for the public health authorities. This matter can best be dealt with by a partnership of local health authority, local authority and the local Road Safety Committees, whose functions could be enlarged to cover by means of a sub-committee this important part of the work of accident prevention in general. Preliminary steps to achieve this end have been taken locally and it is hoped that further developments will take place during 1952. During 1951 the Bexley public mortuary was enlarged and equipped with refrigeration for six bodies. It will also be used by the Crayford and Erith authorities by arrangement with the Bexley Borough Council. I wish to thank the members of the Health Committee for their support and encouragement and the Senior Sanitary 7 Inspector, the Chief Clerk and all members of the Health Department for their devotion to duty at all times during the year. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, JOHN LANDON, Medical Officer of Health. STATISTIC AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 2,698.l Population (Registrar General's estimate mid-year 1951) 27,820 Number of inhabitated houses 8,071 Rateable Value £178,416 Sum represented by a penny rate £726 Live Births. Total M. F. Legitimate 370 194 176 Illegitimate 17 8 9 387 202 185 Birth rate per 1,000 of the estimated home population 13.9. General birth rate for England and Wales 15.5. Stillbirths. Total M. F. Legitimate 9 5 4 Illegitimate — — — 9 5 4 Rate per 1,000 total (live and still) births 22.7. 8 Total M. F. Deaths. 266 136 130 Death rate per 1,000 of the estimated resident population 9.56 General death rate for England and Wales 12.5. The Birth Rate and Death Rate for Crayford compares favourably with that for other parts of the Country. The Registrar General has supplied comparability factors for 1951. The standardised Birth Rate which allows for comparison with other parts of the Country is 12.9 and the standardised Death Rate is 11.6. Maternal Deaths:— There were no Maternal Deaths in 1951. Deiths of Infants under one year of age:— Deaths of Infants under one Total M. F. year of age 8 5 3 Rate per 1,000 live births (Crayford) 20.7. Rate per 1,000 legitimate live births 21.4. General death rate of infants under 1 year of age for England and Wales 29.6. Deaths from Various Causes. Malignant Neoplasm (all ages) 49 Measles (all ages) 1 Whooping Cough (all ages) — Diarrhoea (under 2 years of age) — 10 Vital Statistics during 1951 and previous years. Year Population LIVE BIRTHS DEATHS INFANT DEATHS No, C.U.D.C. RATE C.U.D.C. Eng. & W. No. C.U.D.C. RATE C.U.D.C. Eng. & W. No. C.U.D.C. RATE C.U.D.C. Eng. &W. 1939* 25,200 458 18.26 15 194 9.4 12.1 16 35.4 50 1940* 23,770 428 18 14.6 256 13.8 14.3 16 38.9 55 1941* 22,380 347 15.5 14.2 227 10.1 12.9 20 59.7 59 1942 22,840 441 19.3 15.8 193 8.5 11.6 20 45.3 49 1943 22,850 431 18.9 16.5 223 98 12.1 18 41.8 49 1944 21,910 507 23.1 17.6 243 11.1 11.6 21 41.4 46 1945 23,030 432 18.8 16.1 170 7.4 11.4 10 23.1 46 1946 25,780 566 22 19.1 249 9.7 11.5 21 37 43 1947 26,610 583 22 20.5 271 10.2 12 21 36 41 1948 27,190 501 18.4 17.9 205 7.5 10.8 10 19.9 34 1949 27,520 492 17.9 16.7 221 8.03 11.7 13 26.4 32 1950 27,750 434 15.6 15.8 219 7.89 11.6 12 27.6 29.8 1951 27,820 387 13.9 15 5 266 9.56 12.5 8 20.7 29.6 * Instructions were issued by the Registrar General for these particular years, giving certain alternative figures for calculation of these statistics. SUMMARY OF VITAL STATISTICS, 1951. England and Wales 126 County Boro's and Great Towns (including London) 148 Smaller Towns (Resident population) 25,000 to 50,000 at 1931 Census London Administrative County Urban District of Crayford Rate per 1,000 Home Population BIRTHS. Live 15.5 17.3 16.7 17.8 13.9 Still 0.36 0.45 0.38 0.37 0.32 DEATHS. All Causes 12.5 13.4 12.5 13.1 9.56 Typhoid and paratyphoid 0.00 0.00 0.00 - 0.00 Whooping Cough 0.01 0.01 0.01 0.01 0.00 Diphtheria 0.00 0.00 0.00 0.00 0.04 Tuberculosis 0.31 0.37 0.31 0 38 0 29 Influenza Smallpox 0.38 0.00 0.36 0.00 0.38 0.00 0.23 0.11 Acute poliomyelitis (including polioencephalitis) 0.00 0.01 0.01 0.00 0.00 Pneumonia 0.61 0.65 0.63 0.61 0.5 NOTIFICATIONS. (Corrected) Typhoid Fever 0.00 0.00 0.00 0.01 0.00 Paratyphoid Fever 0.02 0.03 0.02 0.01 0.04 Meningococcal infection 0.03 0 04 0.03 0.03 0.04 Scarlet Fever 1.11 1.20 1.20 1.10 1.26 Whooping Cough 3.87 3.62 4.00 3.11 4.82 Diphtheria 0.02 0.02 0.03 0.01 0.00 Erysipdas 0.14 0.15 0.12 0.15 0.11 Smallpox 0.00 0.00 0.00 - - Measles 14.07 13.93 14.82 14.64 24.5 Pneumonia 0.99 1.04 0.96 0.72 0.75 Acute poliomyelitis (Including polioencephalitis) Paralytic 0.03 0.03 0.03 0.02 0.00 Non-paralytic 0.02 0.02 0.03 0 02 0.07 Food Poisoning 0.13 0.15 0.08 0.23 0.04 deaths. All causes under 1 year Rate per 1,000 Live Births of age Enteritis and diarrhoea 29.6(a) 33,9 27.6 26.4 20.7 under 2 years of age 1.4 1.6 1.0 0.7 0.00 notifications. (Corrected) Rate per 1,030 Total (Live and Still) Births Puerperal Fever and Pyrexia 10.66 13.77 8.08 14.90 5.05 (a) Per 1,000 related live births. 11 Maternal Mortality in England and Wales. Intermediate List No. and cause No. of deaths Rate per. 1,000 Total (Live & Still) Births Kate per Million Women aged 15-44 A115. Sepsis of pregnancy, childbirth and the puerperium 70 0.10 A116. Abortion with toxaemia 3 0.00 0 Other toxaemias of pregnancy and the puerperium 167 0.24 A117. Haemorrhage of pregnancy and childbirth 91 0.13 A118. Abortion without mention of sepsis or toxaemia 37 0.05 4 A119. Abortion with sepsis 66 0.09 7 A120. Other complications of pregnancy, childbirth and the puerperium 125 0.18 Table showing Summary of Causes of Death registered during the year ended 31st December, 1951. CAUSES OF DEATH. Male Female 1. Tuberculosis, respiratory 3 2 2. Tuberculosis, other 2 1 3. Syphilitic disease 2 — 4. Diphtheria l — 5. Whooping Cough — — 6. Meningococcal Infections — — 7. Acute Poliomyelitis — — 8. Measles — 1 9 Other infective and parasitic diseases 1 — 10. Malignant neoplasm, stomach 11 2 11. Malignant neoplasm, lung, bronchus 6 1 12. Malignant neoplasm, breast — 3 13. Malignant neoplasm, uterus — 2 14. Other malignant & lymphatic neoplasm 10 14 15. Leukaemia, aleukaemia — 1 16. Diabetes — — 17. Vasculr lesions of nervous system 12 18 18. Coronary disease, angina 23 11 19. Hvpertension with heart disease 4 5 20. Other heart disease 17 33 21. Other circulatory disease 4 4 22. Influenza 1 2 23. Pneumonia 7 7 24. Bronchitis 7 7 26. Other diseases of respiratory system 3 1 26. Ulcer of stomach and doudenum 1 2 27. Gastritis, enteritis and diarrhoea — — 28. Nephritis and nephrosis 2 — 29. Hyperplasia of prostate 2 — 30. Pregnancy, childbirth, abortion — — 31. Congenital , malformations 1 — 32. Other defined and ill-defined diseases 9 11 33. Motor vehicle accidents 3 1 34. All Other Accidents 4 — 35. Suicide — 1 36. Homicide and operations of war — — All causes Total 136 130 It will be noted that in the table showing Summary of Causes of Death registered during the year ended 31st December, 1951, is recorded a death from Diphtheria. The case refers to a male aged 17 years who when admitted to hospital in April, 1951 was reported to have had Diphtheria at the age of 7 years. Diphtheria was, therefore, only remotely associated with this death which was attributed to this cause for technical reasons only. 13 Births. The 370 live births notified showed a decrease of 64 compared with last year's figure. The birth rate per 1,000 of the population is 13.9 as against 15.6 last year. The birth rate for England and Wales was 15.5. Deaths. This year we recorded 266 deaths out of a population of 27,820 representing a death rate of 9.56 against 7.89 in 1950. The death rate for England and Wales was 12.5. Infants Deaths. During the year 8 infants died before reaching the age of one year. There were 12 in 1950. Rate of Infant Deaths under one year per 1,000 live births was 20.7 as against 27.6 last year. That of England and Wales was 29.6. 14 15 Analysis of the causes of Death of Infants at various ages under one year. Causes of Death as Certified DAYS MONTHS * Total under 1 Year 0 — 1 — 2 — 3 — 4 — 5 — 6 — 7 — 14 — 21 — 28— 2— 3 — 4 — 5 — 6 — 7 — 8 — 9 — 10 — 11— Permaturity 1 1 Atelactasis 1 1 2 Congenital Heart Failure 1 1 Bronco Pneumonia 2 1 3 Asphyxia 1 1 1 1 1 1 3 1 8 *During 1951, 8 infants died before reaching the age of one year, of these 4, that is 50 per cent, occurred in the neonatal period (within one month of birth) the corresponding figure for 1950 was 75 per cent. LABORATORY FACILITIES. The following specimens were sent to the County Laboratory from the District during 1951. Swabs 192 Sputa 92 Faeces 19 Food stuffs 4 Ice Creams 43 Waters 34 Swimming Bath Waters 14 Bacteriological Examinations of Milk 24 Miscellaneous examinations 408 830 PREVALENCE OF AND CONTROL OF INFECTIOUS DISEASE AND OTHER DISEASES. Scarlet Fever. During the year 35 cases were notified. Of these 13 cases were isolated in hospital. The number of cases notified in 1950 was 35. Diphtheria. There were no cases notified in 1951. Enteric or Typhoid Fever. No cases were notified during the year. One case was notified in 1950. Puerperal Pyrexia. Two cases were notified during the year, one less than the previous year's figure. All the cases were from the Russell Stoneham Hospital. One case was removed to Joyce Green Hospital. 16 Public Cleansing. The Council's scheme for the joint use of the Borough of Bexley's Cleansing Station has continued to work satisfactorily. Facilities were available for the disinfection of bedding following cases of infectious diseases, tuberculosis and cancer and for the disinfestation of bedding of verminous persons. PUBLIC MORTUARY. During the year adaptations to the Bexley Mortuary were commenced. When completed the Mortuary, which is to be used jointly by Crayford, Erith and Bexley, will provide a full modern standard of amenities including refrigeration for six bodies. Meningococcal Infection. One case was notified during the year, the same as in 1950. Food P isoning. One case was notified during the year, no cases were notified in 1950. Measles. The number of cases notified in 1951 was 682, two of these were removed to Joyce Green Hospital. The number of cases notified in 1950 was 122. Whooping Cough. 134 cases notified during the year. One case was removed to Joyce Green Hospital. Cases notified in 1950 was 67. Acute Poliomyelitis. 2 cases were notified during the year. Both cases were treated in hospital and were non-paralytic. There were no deaths. 6 cases were notified in 1950. Ophthalmia Neonatorum. No cases were notified during the year. Dysentry. Four cases were notified during the year. One case was notified in 1950. Notifiable Diseases (other than Tuberculosis) during the year. Disease Total cases notified Cases admitted to hospital Deaths Small Fox — — — Scarlet Fever 35 13 — Diphtheria — — — Enteric or Typhoid Fever — — — Paratyphoid Fever 1 1 — Puerperal Pyrexia 2 1 — Pneumonia 21 10 2 Erysipelas 3 — — Meningococcal Infection 1 1 — Measles 682 2 1 Whooping Cough 134 1 — Ophthalmia Neonatorum — — — Dysentry 4 — — Scabies — — — Poliomyelitis (Non Paralytic) 2 2 — Encephalitis 1 1 — Food Poisoning 1 — — Totals 887 32 3 17 h-» 00 Age Groups. Measles Ac. Poliomyelitis Scarlet Fever Diphtheria Whooping Cough (excluding rubella) Paralytic Non Paralytic M F M F M F M F M F M F Under One Year — — — — 4 .7 15 4 — — — — 1 4 — — — 14 13 66 57 — — — — 3 7 3 — — 21 23 108 109 — — — — 5 12 6 — — 25 25 142 171 — — 1 — 10 — 1 — — — 1 4 1 — — — — 15 1 1 — — — — 1 1 — — — — 25 and over — — — — — 1 — 1 — — — 1 Age unknown — — — — — — 1 1 — — — — Total (All Ages) 24 11 — — 64 70 337 345 — — 1 1 Enteric or Typhoid Fever Paratyphoid Fevers Ac Pneumonia Dysentery Meningococcal Infection Ac encephalitis lethargica M F M F M F M F M F M F Under 5 Years — — — — 1 1 — — — 1 — — 5 — — — — 3 1 — — — — — 1 15 — — — — 2 2 — 4 — — — — 45 — — — — 4 2 — — — — — — 65 and over — — — 1 2 2 — — — — — — Age unknown — — — — 1 — — — — — — — Total (All Ages) — — — 1 13 8 — 4 — 1 — 1 19 Age Groups Continued. Erysipelas Smallpox Food Poisoning M F M F M F M F Puerperal pyrexia — 2 Ophthalmia neonatorum — — 0 — — — — — — Scabies 5 1 1 — — — — 15 — 1 — — — — 45 — — — — — 1 65 and over — — — — — — Age unknown Total (All Ages) 1 2 — — — 1 20 Immunisation against Diphtheria and Vaccination against Smallpox, 1951. The following is a return received from the County Medical Officer of Health of (A) the number of children resident in the Crayford area who were immunised against Diphtheria and (B) the number of persons who were vaccinated against Smallpox during the year ended 31st December, 1951. (A) Diphtheria Immunisation. Year of Birth 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 Total Primary. Inoculations 36 230 23 7 2 8 9 6 5 8 2 5 13 17 24 395 Reinforcing Inoculations — — — — 66 234 25 20 19 28 18 19 52 75 123 679 (B) Vaccination. Age at 31st December, 1951 Under 1 1 to 4 5 to 14 15 or over Total Number Vaccinated 124 105 20 15 264 Number Re-vaccinated — 2 8 47 57 The following is a return of the number of children resident in the Crayford area under the age of 15 years on 31st December, 1951, who had completed a course of immunisation at any time before that date (i.e. at any time since 1st January, 1936). Year of Birth 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 Total 148 143 257 391 240 279 271 523 621 392 395 403 350 288 36 4737 Tuberculosis. Age periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F 0 — — — — — — — — 1 1 1 — — — — — — 5 2 1 — — — — — 1 15 1 7 1 1 1 — 1 — 25 2 3 — 1 — — — — 35 — 3 — — 1 1 1 — 45 2 — — — 1 1 — — 55 5 — — — — — — — 65 and upwards — — 1 — — — — — Totals 13 15 2 2 3 2 2 1 Chest Clinics. At West Hill Hospital, Dartford, and 65, Bexley Road, Erith. Housing Applicants. Special consideration is given to cases put forward by the Medical Officer of Health involving tuberculosis or other physical disability in the applicants' families and such cases are considered outside the normal points scheme. Cases investigated during the year—44. Applicants recommended for rehousing—8 No. of families granted houses on account of Tuberculosis—6. TUBERCULOSIS AFTER-CARE. It was brought to my notice that the question of appointing a separate Tuberculosis Care Committee for the Crayford District had been raised. The area was then being served by the Erith and Dartford Committees. A Meeting was convened of Organisations interested in welfare work by the Chairman of the Crayford Urban District Council, as a result of which the Crayford District Tuberculosis Care Committee was formed in Association with the 21 Kent Council of Social Service, to provide comforts for patients, and their dependents, suffering from tuberculosis. In the interests of the prevention of the spread of infection, a Lending Library was opened to supply books to patients. The Council provided a room for the accomodation of the books. Occupational Therapy is part of the service given by the Care Committee, and a variety of hand crafts have been taken up by the patients. The Council took the initiative in the setting up of the Committee which has proved well worth while, and much good work has been done. WELFARE OF OLD PEOPLE. Extreme difficulty was still being experienced in 1951 in getting old people admitted to hospital who were ill and in varying degrees of destitution. Local Hospital Management Committees had plans for increasing the number of beds for old people, but the position had not improved. A Council resolution forwarded to the Dartford and Woolwich Committees stressed the serious view taken in this matter, and urged them to take all possible steps to alleviate the position. I think it can be said that the position is, at the present stage, a little better. Many old people living alone are finding themselves in difficulties at the present time, particularly when they are ill and unable to take care of themselves. Old people need help in many directions. This includes the provision of home nursing, domestic help and the help of the National Assistance Board in regard to extra bedding, clothing. They also need help with their shopping and in getting to and from hospital when this is necessary. The following are a few typical cases in which help was given during the year :— Case No. 1. This was a case of an old man aged 86 years who had been living alone since the death of his wife, in very bad conditions. The home had become extremely dirty, the 22 man was very ill and in need of care and attention. An effort was made to install a domestic help immediately. The man appeared to be agreeable, but when the help arrived he steadfastly refused her admission. Contact was made with the Geriatric Specialist and the patient was admitted to hospital the next day, where he died shortly afterwards. Case No. 2. Was a man aged 80 years, who was confined to bed through illness. He had no proper bed clothing, his bed being covered with old rags and dirty old coats. Contact was made with the National Assistance Board and with the Women's Voluntary Service who provided him with quilts. The man, who was in a very serious condition, was later admitted to hospital where he died the following day. These two cases appeared to be in the last extremity of suffering, but many old people have been assisted to* a better enjoyment of life, through the help they have been given in dealing with their personal problems. Our thanks are due to the members of the Crayford Good Neighbours Association who have regularly visited these old people in their own homes, and have assisted them in many ways referred to above. To the Women's Voluntary Service, the St. John Ambulance Brigade and Nursing Division and the British Red Cross Society thanks must also be extended. Domestic Help. The Kent County Council's Domestic Help Scheme has rendered invaluable assistance to old people. 65 families between the ages of 70 and 90 years have received this assistance during the year. INSPECTION AND SUPERVISION OF FOOD. Meat. A specimen of sausage meat suspected of bacterial contamination was forwarded to the County Laboratory Examination revealed no organisms of the food poisoning group and the sample was found to be free from poisonous metals and their compounds and no evidence of putrefaction. 23 Cheese. A carton of Italian cheese alleged to contain foreign matter proved on examination to contain white crystals of sodium phosphate—a harmless substance. Bread. Complaint was received regarding a cockroach found embedded in a loaf of bread. A warning letter was sent to the baker concerned. Jam. A complaint was made concerning a splinter of glass found in a jar of raspberry jam. A warning letter was sent to the manufacturers concerned. Ham. A sample of cooked ham forwarded for examination was found to be in a state of early decomposition and unfit for food. Fish. A tin of Norwegian sild alleged to have caused sickness was sent for examination but no food poisoning organisms were found. Fruit. Complaint was made regarding maggots in an orange. These were identified as maggots of the Mediterranean Fruit Fly (Ceratitis Capitata). Ice Cream. Contravention of Section 14 of the Food and Drugs Act, 1938. Legal proceedings were instituted against an ice cream vendor for storing ice cream in premises which were not registered and which by virtue of their unsuitability could not be registered. Defendent was fined £10. Milk. Licences granted by the Council under the Milk (Special Designations) (Pasteurised and Sterilised Milk) Regulations, 1949. Supplementary:— Tuberculin Tested, 6. Pasteurised, 7. Sterilized, 8. 24 Dealers:— Tuberculin Tested, 4. Pasteurised, 4. Sterilized, 14. Meat and Other Foods. The following articles were found during the year to be unfit for human consumption. Beef 85¼ lbs. Corned Beef 137¼ lbs. Pork 39½ lbs. Tinned Pork 6 Tins Tinned Ham 406 lbs. Rabbits (70) 147lbs. Chickens (34) 82 lbs. Turkeys (2) 23 lbs. Offal 111 lbs. Sausages 6 lbs. Tinned Sausages 50 Tins Jellied Veal 8 lbs. Fish 413 lbs. Tinned Fish 8 Tins Bacon 48½ lbs. Cheese 35½lbs. Luncheon Meat 57 Tins Fruit and fruit juices 50 Tins Beans 18 Tins Peas 74 Tins Vegetables 16 Tins Peanut Butter 12 Jars Jams 15 Tins and Jars Milk 24 Tins Eggs 49 Miscellaneous Articles 26 All premises where food is stored or prepared for sale were regularly inspected and it is evident that there is growing consciousness on the part of the food traders that they have a responsibility to the public in regard to the proper handling and storage of food. During the year a number of traders installed additional refrigeration facilities and others have placed orders for refrigeration plant. Three food premises in the area were found to have unsuitable and inadequate storage facilities. Representations were made resulting in major alterations and improvements to the premises being made. There are no Government slaughterhouses within the area but Cottagers' Pigs are regularly examined. The number of pigs slaughtered during the year was 15, all carcases being passed as fit for human consumption. All restaurants and canteens were inspected from time to time during the year. The bulk of the Ice Cream sold in the area is supplied by reputable firms and results taken during the year proved that the ice cream was generally of a high standard. 25 FOOD AND DRUGS ACT, 1938. Details of Samples taken by the County Sampling officer within the Urban District of Crayford during the year ended 31st December, 1951:— Article No. Article No. Acid Drops 1 B/fd. 30 Almonds, Ground 1 Kilkoff 1 Apricots 1 Koray 1 Aspirin 1 Liquafruta 1 Balsam 1 Liver Salts 1 Batter Mixture 1 Macaroni 1 Black Pudding 1 Milk 21 Borax 1 Oatmeal 1 Cheese 2 Pepper 1 Chicken 1 Pressed Beef 1 Chicken Noodle Soup 1 Rennies 1 Cocoanut 1 Rice 2 Condensed Milk 1 Sago 1 Cough Syrup 1 Sausages 5 Cream 1 Sausage Rolls 1 Epsom Salts 1 Seidlitz Powder 1 Eucalyptus l Skim Milk Powder 1 Flour 1 Soothing Powder 1 Fruit Salad 1 Soup 1 Glauber Salts 3 Sponge Mix 1 Glycerine 1 Throat Tablets 1 Glycerine and Thymol 1 Vinegar 1 Golden Spread 1 Whiskey 5 Ice Cream 2 Yeast Vite 1 Inhalent 1 Yoghourt Milk 1 Jelly Crystals 1 Zinc and Castor Oil Cream 1 C/fd. 30 TOTAL 88 All the above samples were genuine with the exception of the following Sample of Analysis Action taken Pure Glauber Salts Consisted of Stocks destroyed exsiccated Glauber Salts Pure Glauber Salts '' Pure Glauber Salts " 26 Skim Milk Powder Moisture 5.1% Stocks returned to Solubility 90.6% the Ministry of Acidity 1.75% Food Deterioration sufficient for condemning. Rybarex Inhalent Genuine. (Formulae Manufacturers on Bottle and outer notified container do not agree) BYFLAWS UNDER SECTION 15 OF THE FOOD AND DRUGS ACT, 1938. Under this Section two traders were warned for contravening the Byelaws, but it was not found necessary to take statutory action. CLEAN FOOD CAMPAIGN. In my report for 1950 I referred to the Clean Food Campaign being organised in conjunction with the Boroughs of Bexley and Erith. A result of the Campaign has been the formation of a Food Traders' Guild for the three areas. Codes of ractice have been formulated and completed copies of the appropriate Codes and letters inviting membership to the Guild have been sent to the food traders. CLEAN FOOD EXHIBITION. A Clean Food Exhibition was held in conjunction with the Boroughs of Bexley and Erith in the Town Hall, Crayford from the 21st to 25th May, 1951. Approximately 1,000 attended. Parties of school children visited the Exhibition from the three areas under the supervision of their school teachers. Notes on the Exhibition. The Clean Milk Stand told the story of milk from cow to consumer; its production, cooling, transport, pasteurisation and bottling; its constituent elements and food value; and the dangers of any misuse of milk bottles by the public. The Ice Cream Stand contained a completely self-contained exhibition unit depicting the progress which has been 27 made by the ice cream industry during recent years, in regard to standards of cleanliness and improvements in quality. The Stands provided by the Ministry of Health and the Central Council for Health Education showed the causes of food poisoning illustrated by bacterial cultures, charts and photographs, etc. Personal hygiene and the protection it affords being strongly emphasised. The exhibit of the Ministry of Food directed attention to the Model Byelaws which have been adopted by the three Authorities. The centre unit of this exhibit being a m del of a street with two shops—the good shop and the bad shop— selling groceries, provisions and meat. Preservation of Food consisted of refrigerated display cabinets containing meat and provisions and a refrigerated fish slab shown in actual working order. Also an electric refrigerator and other electrical equipment relating to cleanliness in food handling was shown. The Health Department's exhibits dealing mainly with food inspection showed the steps taken by Local Authorities to safeguard the food supplies to the public. Illustrated by specimens. An item which proved of great interest to the younger visitors was the Infestation Control Stand showing something of the work of the Infestation Control Division of the Mini try of Agriculture and Fisheries, which included, among other things, a number of live exhibits of the many pests which attack food. A Film Unit provided by the Ministry was in operation during the week, and films appropriate to the occasion were shown. Other exhibits were Metal in Food, a working electronic Metal Detector depicting the method of detecting minute quantities of metallic impurities in food; Welfare Foods and School Meal Service. A fine spirit of co-operation was shown by all the exhibitors and the tastefully arranged stalls were both educational and attractive. 28 The Control of Rodents and other Pests. During the year the following infestations were dealt with:— Rats 100, Mice 51, Wasps 12, Ants 19, Woodworm 21, Miscellaneous 11. HOUSING STATISTICS. (1) Inspection of Dwelling-Houses. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 862 Number of inspections made for that purpose 2892 2) Number of Dwelling-houses (included under sub-heading (1) above which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 11 Number of inspections made for that purpose 48 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 8 4) Number of dwelling-houses (exclusive of those referred to under the preceding subheading) found not to be in all respects reasonably fit for human habitation 310 (2) Remedy of defects during the year without Service of formal Notices. umber of defective dwelling-houses rendered fit in consequence of informal action by Local Authority or their Officers 375 One motor bus body used for human habitation was closed by arrangement with the owner. (3) Action under Statutory Powers during the year. tatutory Notices under Housing or Public Health Acts 14 1 (3) Number of dwelling-houses in respect of which demolition orders were made 8 Number of dwelling-houses demolished in pursuance of demolition orders 1 Total number of houses owned by local authority 1680 29 Number of houses built during the year:— (a) by the Local Authority 32 (b) by other bodies or persons 9 (4) Housing Act, 1936, Part IV.—Overcrowding. Whilst it is known from the particulars supplied by housing applicants that overcrowding does exist it is impossible to state the extent of such overcrowding. SANITARY CIRCUMSTANCES OF THE AREA Water. The Metropolitan Water Board is the supplying authority. The supply to the Crayford district is a mixture of water from Crayford, Dartford, Darenth, Wansunt and Wilmington wells. All the water is chlorinated on the works, but, any excess remaining after a period of contact is removed completely before the water is passed into supply. Bacteriological analyses are carried out at least five times per week of all supplies both before and after chlorination and 100 per cent, first class results were obtained during the year. All new and repaired mains are chlorinated before being restored to use and samples of water from them are tested to see that the quality conforms with that normally supplied before the main is passed for service. None of the supplies is plumbo-solvent. Water Sampling. The following samples were sent to the County Laboratory by the Council's Sanitary Inspectors. All the samples were reported satisfactory except two, taken from domestic supplies. In one case the Count was described as high. This related to stored water. The Storage Tank was in need of cleansing and new covers. Further samples forwarded after the tank had been cleansed and new covers provided were reported satisfactory. The other case was a complaint of unpalatable water. The water was reported by the Analyst to contain minute quantities of copper, but insufficient to be injurious to health. (a) Wells (drinking water), Bacteriological 24. (b) Swimming Pool, Bacteriological 14. (c) Domestic Supplies, Bacteriological 10. (d) Domestic Supplies, Chemical 3. 30 Drainage and Sewerage. In a number of cases minor defects were discovered in sewers and drains during the course of sewer maintenance treatments for rodent infestations, and also a number of defective drains were located, steps were immediately taken to have these put right. Rivers and Streams. All seasonal clearance of streams had been completed in the District. In addition the Kent River Board's mechanical excavator had been engaged in the removal of mud banks from the River Cray. Some nuisance was occasioned in June by the dumping of tortoises into the river, and hundreds of these were removed by the Board's workmen and disposed of by the Council. The River Cray was polluted with oil during November The source was located and necessary action taken. The normal annual maintenance work was carried out on the ditches, water-ways, and rivers, in the district. Closet Accommodation. Approximate number of premises containing each type of sanitary convenience in the district :— W.C's. into drainage system, approximately 10,000 W.C's. into Cesspools 16 Number of premises not connected to public water supplies 0 Refuse Collection. A seven day collection of refuse was maintained under the same system as previously. Sankary Inspection of the Area. No. in district No. of visits in 1951 No. of faults and defects found No. of faults and defects remedied Bakehouses 1 6 0 0 Milk Shops 2 30 0 0 Other food - preparing places, which are, as such, subject to inspection 53 662 13 14 31 Nuisances and defects remedied during the year (other than those enumerated in the previous tabulation). Overcrowding 5 Sanitary Accommodation : Defective 24 Drainage : (i) Repaired 73 (ii) Cleansed 229 Refuse Receptacles 30 Dampness 99 Roofs and Rain Water Pipes 77 Floors 168 Walls and Ceilings 338 Baths, Lavatory Basins and Sinks 11 Water Supplies 15 Doors & other woodwork 21 Other works 38 Windows & Ventilation 209 Accumulation of Refuse 5 Total number of visits of all kinds paid by Inspectors during the year 6966 Approximate number of rated premises in the area 565 Notices served :— Statutory 14 Informal 323 Number of houses, etc., disinfected 59 Swimming Pool. Period open from the 12th May, to the 16th September. Number of bathers 28,741. This figure does not include School Parties and Clubs. Shop Acts. Visits made during the year 285. Stroke Abatement. No action taken. Eradication of the Bed Bug. Particulars of the action taken in 1951 for the eradication of the Bed Bug are as follows :— Number of Infested Disinfested Council Houses 20 20 Other Houses 2 32 Prescribed particulars on the administration of the Factories Act, 1937. 1. Inspections for purposes of provisions as to health (including inspections made by Sanitary Inspectors). Premises (i) Number on Register (2) Number of Inspections (3) Written notices (4) Occupiers prosecuted (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 13 26 2 — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 52 138 3 — (iii) Other Premises in which Section 7 is enforced by Local Authority (excluding outworkers' premises) 18 9 1 — TOTAL 83 173 6 — 33 2. Cases in which Defects were found. Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H. M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S.1) — — — — — Overcrowding (S.2) Unreasonable temperature (S.3) — — — — — Inadeqate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7) (a) Insufficient 4 2 — 1 — (b) Unsuitable or defective 2 2 — 1 — (c) Not separate for sexes — — — — — Other offences (not including offences relating to Outwork) — TOTAL 6 4 — 2 — 34 (Sections 110 and 111). OUTWORK. Part VIII of the Act. Nature of Work. Section 110 Section 111 No. of out-workers in August list required by Sect. 110 (1) (c). No. of cases of default in sending lists to the Council. No. of prosecutions for failure to supply lists. No. of instances of work in unwholesome premises. Notices Served. Prosecutions. Wearing Apparel. Making, etc. 16 — — — — — Carding, etc. of buttons, etc. 2 — — — — — Total 18 — — — — — 35